Haldimand Norfolk Health Unit INFLUENZA PANDEMIC PLAN

Transcription

1 2010 Haldimand Norfolk Health Unit INFLUENZA PANDEMIC PLAN

2 Table of Contents Executive Summary... iv Acronyms... v Chapter 1: Background Influenza Pandemic Why Plan for an Influenza Pandemic? What is Influenza? What is an Influenza Pandemic?... 9 Chapter 2: Roles, Responsibilities and Frameworks for Decision Making Roles of Government International Activities (World Health Organization) National Activities (Public Health Agency of Canada) Provincial Activities (Ministry of Health and Long-Term Care) Local Activities (Haldimand County and Norfolk County) Haldimand-Norfolk Health Unit Activities Incident Management System Responding to an Emergency Using IMS The HNHU s IMS Team A Incident Commander B Operations In-Charge C Planning In-Charge D Logistics In-Charge E Finance In-Charge F Liaison and Public Information Officer In-Charge G Safety Officer Operation Cycle Timing of the Operation Cycle Meeting Portion of the Operation Cycle Working Portion of the Operation Cycle Ethical Framework for Influenza Pandemic Planning, Response and Recovery Decision-Making Principles Core Ethical Values Legislation Legal Basis Legal/Legislative Framework Health Protection and Promotion Act Emergency Management and Civil Protection Act Personal Health Information Protection Act ii Haldimand Norfolk Health Unit Influenza Pandemic Plan 2010

3 2.5.6 Quarantine Act Coroners Act Occupational Health and Safety Act Chapter 3: Planning Approach and Teams Development of the HNHU Pandemic Plan Purpose and Scope Goals Objectives Additional Implications and Assumptions HNHU Emergency Control Group Responsibilities by Pandemic Phases Influenza Pandemic Plan Maintenance Testing the Plan Maintenance Review and Business Cycle Duties of Involved Agencies Chapter 4: Formalizing the Emergency Process Activating the HNHU Pandemic Response Plan Coordination of the Municipal Response Chapter 5: Surveillance Goals of Pandemic Surveillance Objectives of Pandemic Surveillance Elements of a Comprehensive Surveillance System Surveillance Activities School Absenteeism A Indicator Definition B Surveillance Setting C Surveillance Population D School Absenteeism Activity Indicator Data Elements by Pandemic Period Hospital Emergency Department FRI Surveillance A Indicator Definitions B Surveillance Setting C Surveillance Population D Hospital Emergency Department FRI/ILI Activity Indicator Data Elements by Pandemic Period E Case Data Collection Method Primary-Care Sentinel Site ILI Surveillance A Indicator Definitions B Surveillance Setting C Surveillance Population D Background History of Indicator Use E FluWatch iii Haldimand Norfolk Health Unit Influenza Pandemic Plan 2010

4 5.4.3F Primary Care Sentinel Site FRI/ILI Activity Indicator Data Elements by Pandemic Period G Implementation Haldimand and Norfolk Surveillance Activities by Pandemic Phases Chapter 6: Public Health Measures The Goal Instituting Public Health Measures Objectives of Instituting Public Health Measures Public Education Travel and Border-Related Measures Case Management Active Surveillance Quarantine Community-Based Disease Containment Strategies Social Distancing Large Gathering Restrictions/Cancellations School and Day Nursery Closures Chapter 7: Antivirals and Vaccines Goal Objectives Haldimand and Norfolk Antiviral and Vaccine Activities by Pandemic Phases Antiviral Medications Treatment Prophylactic Use Monitoring Adverse Reactions Distribution Vaccines Next Steps Chapter 8: Communications The Goal of the HNHU s Pandemic Communications The Objectives of the HNHU s Pandemic Communications Local Communications Activities by Pandemic Phase Communications Methods/Information Cycle Clock External Stakeholders Internal Stakeholders Appendix 1: Pandemic Plan Distribution List Appendix 2: Definitions and Relevant Terms iv Haldimand Norfolk Health Unit Influenza Pandemic Plan 2010

5 Executive Summary The first draft of the Haldimand-Norfolk Health Unit Influenza Pandemic Plan (2010) is the first formal pandemic plan developed by the Haldimand-Norfolk Health Unit (HNHU). It was developed in accordance with the Ontario Health Plan for an Influenza Pandemic (OHPIP). The OHPIP, which was developed by the Ministry of Health and Long-Term Care (MOHLTC), outlines a provincial pandemic preparedness and response plan that relies on information obtained from surveillance activities for detecting and monitoring influenza and provides information to guide local pandemic groups. Hence, the OHPIP is heavily reference in the HNHU Influenza Pandemic Plan. The HNHU Influenza Pandemic Plan (HNHUIPP) was developed in response to the existing threat of a possible influenza pandemic. Its value, however, goes beyond assisting with the community response to a possible pandemic. Many of the aspects of the influenza pandemic plan will also assist in responding to other health-related emergencies relating to biological, chemical, radiological, or nuclear agents or events. As well, the working relationships established among the many stakeholders involved in the development of this plan will facilitate planning and responding to other emergencies and health-related issues. Therefore, the goals of the HNHUIPP are as follows: 1. To minimize serious illness and overall deaths through appropriate management of Haldimand and Norfolk's health-care system. 2. To minimize societal disruption in Haldimand and Norfolk as a result of an influenza pandemic. The HNHUIPP provides an overview of the Health Unit s pandemic preparedness and various options for implementation. It has been fundamentally understood that changes in policy and approaches for pandemic planning by provincial, federal and international governments, as well as the epidemiology of the pandemic, will require updates to existing chapters as well as new chapters and tools designed to guide and support further planning across Haldimand and Norfolk. v Haldimand Norfolk Health Unit Influenza Pandemic Plan 2010

6 Acronyms BIOS Biological Inventory Operating System CCAC Community Care Access Centre CDC Centers for Disease Control and Prevention (US) CD Communicable Disease CEMC Community Emergency Management Coordinator CEPR Centre for Emergency Preparedness and Response CIDPC Centre for Infectious Disease Prevention and Control CIHR Canadian Institute of Health Research ECG Emergency Control Group EMO Emergency Management Ontario EMS Emergency Medical Services EMU Emergency Management Unit EOC Emergency Operations Centre ERP Emergency Response Plan ESW Essential Service Workers F/P/T/L Federal/Provincial/Territorial/Local FRI Febrile Respiratory Illness HBHC Healthy Babies Healthy Children HCW Health Care Worker HE Healthy Environment HEAS Health Emergency Alerting System HERT Health Emergency Response Team HHR Human Health Resources HNHU Haldimand-Norfolk Health Unit HNHUIPP HNHU Influenza Pandemic Plan HPFB Health Protection Food Branch HPPA Health Protection and Promotion Act IMS Incident Management System ICP Infection Control Practitioner ILI Influenza-Like Illness IPP Influenza Pandemic Plan LTCF Long-Term Care Facilities MOH Medical Officer of Health MOHLTC Ministry of Health and Long-Term Care NACI National Advisory Committee on Immunization NESS National Emergency Stockpile System NIOSH National Institute Occupational Health & Safety NML National Medical Laboratory NML4 National Medical Laboratory Level 4 OHPIP Ontario Health Pandemic Influenza Plan OH&S Occupational Health and Safety vi Haldimand Norfolk Health Unit Influenza Pandemic Plan 2010

7 PAHO PHA PHAC PHD PIC POC PPHB PTAC UIIP VAAE VAER VON VPD WHO Pan American Health Organization Public Health Act Public Health Agency of Canada Public Health Division, MOHLTC Pandemic Influenza Committee Provincial Operations Centre Population and Public Health Branch Provincial Transport Authorization Centre Universal Influenza Immunization Program Vaccine-Associated Adverse Event Vaccine Adverse Events Reporting Victoria Order of Nurses Vaccine Preventable Disease World Health Organization vii Haldimand Norfolk Health Unit Influenza Pandemic Plan 2010

8 Chapter 1: Background Influenza Pandemic 1.1 Why Plan for an Influenza Pandemic? Influenza has been with us for centuries. It causes severe illness and death every winter in North America and the rest of the world, attacking the elderly and the debilitated with particular ferocity. A novel strain of the influenza virus, to which the population has no immunity, emerges three or four times a century. The novel virus spreads quickly, causing large-scale outbreaks of influenza over a large geographical area, often worldwide. Outbreaks of this nature are known as pandemics. Pandemic influenza tends to occur in two or three waves, sometimes over a long period, before finally abating. Three influenza pandemics occurred in the 20th century: the Spanish (1918), Asian (1957) and Hong Kong (1968) pandemics. The Spanish pandemic killed an estimated 20 to 40 million people worldwide. 1.2 What is Influenza? Influenza, or the flu, is a highly contagious and common respiratory illness caused by a virus. There are three known types of influenza virus: A, B and C. Influenza A and B viruses are subtyped according to two proteins on the surface of the virus: hemaglutinin (H) and neuraminidase (N). Sixteen different H subtypes and nine different N subtypes have been identified. Influenza A and B cause seasonal influenza, but only influenza A is associated with pandemics. The vast majority of influenza is transmitted from person to person by droplet spread or direct contact. Droplet spread refers to spray with relatively large, short-range droplets produced by sneezing, coughing, talking or singing. These droplets may spray up to one metre (about three feet) and can land directly in the eyes or be breathed in through the nose or mouth. Direct contact occurs when there is immediate transfer of the virus through skin-to-skin contact or kissing. For example, this can occur by shaking hands with someone who has infectious mouth or nose secretions on his or her hands. For most adults, the period of communicability is from 24 hours before and up to three to five days after symptoms develop. Children and some adults may be infectious for seven or more days after the onset of symptoms. The incubation period is one to three days. Humans are the primary source for human infections. However, birds and mammals such as swine can provide sources of new human subtypes of influenza virus. About half of influenza infections are asymptomatic, while the other half show a spectrum of symptoms from mild to severe. These include the following: Haldimand Norfolk Health Unit Influenza Pandemic Plan

9 Sudden onset of fever, headache, chills, muscle aches, physical exhaustion and a dry cough. Subsequent onset of sore throat, stuffy or runny nose and worsening cough. Children may also feel sick to their stomach, vomit or have diarrhea. Elderly and immune-compromised people may not develop a fever. Most people recover in seven to 10 days. These symptoms are non-specific and may be caused by other viruses or bacteria. Diagnosis of influenza cases depends on laboratory testing and epidemiological characteristics. For most people, the "seasonal" flu is not life threatening. The most seriously affected by seasonal flu are young children (less than two years old), people with chronic medical conditions and the elderly. Specifically, they are at increased risk of developing complications, such as pneumonia, which can be fatal. However, a novel virus may not affect the same groups. The influenza virus is constantly changing and mutating. This usually results in minor changes (antigenic drifts) in the virus protein structure, which cause influenza illness and outbreaks every winter (November to April). A new vaccine is developed every year based on current and emerging viral strains identified through worldwide disease surveillance. 1.3 What is an Influenza Pandemic? An influenza pandemic occurs when there is an abrupt and major change in the protein structure of the influenza A virus, resulting in a new subtype. This is known as an antigenic shift. This change may occur in two ways. When two viruses infect the same cell, they may share genetic material (re-assortment) and result in a new human virus. Alternatively, a virus may undergo random mutation, resulting in an adaptive form more likely to survive in the host. This second type of change may occur during sequential infection of humans and other mammals and lead to a virus more efficiently transmitted among humans. The conditions for the development of a pandemic include the following: Emergence of a novel influenza A subtype as a result of an antigenic shift. Efficient and sustained person-to-person viral transmission. A high proportion of susceptible people in the population with little or no immunity. Haldimand Norfolk Health Unit Influenza Pandemic Plan

10 Capacity of a new virus to cause serious clinical illness and death. Since people have little or no immunity to this new strain, it can spread quickly, causing outbreaks in one or more countries or worldwide. This is called a pandemic. The exact nature of the pandemic virus (e.g., virulence, presentation, period of incubation, transmissibility and routes of transmission) and illness will not be known until it emerges. The following conditions make a pandemic more likely: A new influenza virus showing antigenic shift. This shift creates a new strain of influenza virus to which no one would have immunity. A susceptible population. Evidence that the virus is transmitted from person to person. Evidence of the new virus s virulence. Seasonal Influenza vs. Pandemic Influenza The following chart summarizes the main differences between seasonal influenza and pandemic influenza: Seasonal flu Occurs every year (October to April). Occurs during the winter. For most people, it is an unpleasant but not life-threatening infection. Most people recover within one or two weeks without medical treatment. The very young, the very old and people with chronic illness are most at risk of serious illness. Vaccine is available in advance. Annual vaccination is recommended, especially for those at risk of serious illness. Antiviral drugs are available to treat those at special risk. Pandemic flu Occurred three times in the 20th century. Occurs at any time of the year. It is typically a more serious infection for everyone. Some people will not recover even with medical treatment. Due to the higher severity of illness, there is greater risk of death. People of every age may be at risk of serious illness. Vaccine will not be available in advance. The whole population will be vaccinated when vaccine becomes available. Antiviral drugs are likely to be in limited supply and will be used to best effect according to how the disease develops. Sources: Department of Health (England) Pandemic Flu: Frequently Asked Questions October Ministry of Health and Long-term Care Differences between seasonal or annual influenza and the influenza pandemic Fact Sheet. Haldimand Norfolk Health Unit Influenza Pandemic Plan

11 Chapter 2: Roles, Responsibilities and Frameworks for Decision Making Viruses do not adhere to borders. Planning must occur internationally, nationally, provincially and locally to help restrict the geographical distribution of any pandemic. A coordinated and collaborative approach to combat pandemic influenza enables effective communication between health authorities at all government levels. Past tragedies have taught us that the efficient flow of accurate information is crucial during a time of emergency. The Haldimand-Norfolk Health Unit s Influenza Pandemic Plan (HNHUIPP) operates in reference to and reflects: The World Health Organization's (WHO's) pandemic periods and phases. The Canadian pandemic planning phases created by the Public Health Agency of Canada (PHAC). Collaboration with the Canadian Pandemic Influenza Plan. Collaboration with the Ontario Health Plan for an Influenza Pandemic (OHPIP). The framework of incident management systems for decision-making. An ethical framework to guide decision-making. All relevant provincial and municipal legislation. 2.1 Roles of Government International Activities (World Health Organization) Overall, the WHO is responsible for declaring a pandemic and coordinating a global response. While coordinating international efforts to assist national and local authorities, the WHO also provides international surveillance and reporting during inter-pandemic periods. If there is an onset of a pandemic, the WHO will make recommendations for the composition and use of vaccines (i.e., doses and schedules) and provide guidance on the best use of available antiviral drugs. Being responsible for declaring a pandemic and coordinating a global response, the WHO has created the backbone of pandemic planning: the WHO Classification System. The WHO phases are meant to guide planning efforts and are incorporated into the Canadian, Ontario, and Haldimand and Norfolk plans. The WHO will identify which phase is currently occurring internationally and will declare the beginning of a pandemic. Haldimand Norfolk Health Unit Influenza Pandemic Plan

12 The following table identifies the WHO Pandemic Phase Model (as of 2008): World Health Organization Pandemic Phases Interpandemic No new influenza virus subtypes have been detected in humans. An Phase 1 Period* influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered low. Phase 2 No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial Pandemic Alert Period** Pandemic Period Postpandemic Period risk of human disease. Phase 3 Human infection(s) with a new subtype, but no human-to-human spread, or at most, rare instances of spread to a close contact. Phase 4 Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Phase 5 Larger cluster(s), but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Phase 6 Increased and sustained transmission in general population. Return to inter-pandemic period. * The distinction between Phase 1 and Phase 2 is based on the risk of infection or disease from circulating strains in animals. ** The distinction between Phase 3, Phase 4 and Phase 5 is based on the risk of a pandemic National Activities (Public Health Agency of Canada) At the national level, the Government of Canada is responsible for coordinating the nationwide response to an influenza pandemic. This will involve: Communicating with international and national agencies to coordinate surveillance, investigation and vaccine activities. Obtaining and distributing diagnostic reagents and technical information to laboratories. Antiviral and vaccine manufacturing and distribution to provinces and territories. Haldimand Norfolk Health Unit Influenza Pandemic Plan

13 One must consider that the WHO s phases reflect an international risk level and do not necessarily reflect virus activity on a national scale. To help national planning and response activities, the Public Health Agency of Canada has created a scale in conjunction with the WHO s periods and phases that reflects pandemic influenza activity in Canada. The Canadian activity level number will be used with the WHO phase number to confirm the level of pandemic activity in Canada. Example of WHO/CAN Pandemic Activity Levels WHO CAN Phase WHO/CAN Phase Definition Phase Outside Canada, increased and sustained transmission in the general population has been observed. No cases detected in Canada Single human case(s) with the pandemic virus detected in Canada. No cluster(s) indentified in Canada Localized or widespread pandemic activity observed in the Canadian population. Adopted from OHPIP, August Provincial Activities (Ministry of Health and Long Term Care) Working in coordination with the Government of Canada and municipal governments, the Government of Ontario is responsible for planning and managing the response to a pandemic in Ontario. This will involve: Communicating with national and municipal agencies to coordinate surveillance, investigation and vaccine activities. Coordinating investigations of outbreaks and clusters of febrile respiratory illness (FRI) and influenza-like illness (ILI). Supply, vaccine and antiviral purchasing, stockpiling and distribution. Providing guidance and direction to local public health authorities and the healthcare system. Coordinating public education programs Local Activities (Haldimand County, Norfolk County, HNHU) Haldimand County and Norfolk County, in conjunction with the HNHU, are responsible for coordinating the local response to a pandemic. This will involve: Developing Pandemic Plans that address a county-wide response for Haldimand County and Norfolk County. Developing a Pandemic Continuity of Operations Plan for Haldimand County and Norfolk County. Haldimand Norfolk Health Unit Influenza Pandemic Plan

14 Maintaining municipal infrastructure and essential services. Assisting the HNHU in obtaining resources. Establishing clear communication strategies/systems amongst county departments, essential service providers, partners and stakeholders. Communicating to the public information regarding municipal response activities and service provision(s). Liaising with local community partners and stakeholders Haldimand Norfolk Health Unit Activities Mandated by the Ontario Public Health Standards, pandemic planning is a component of the HNHU s Emergency Preparedness Program. As a component of this program, HNHU activities will involve: Developing a Pandemic Plan that addresses the HNHU s response. Developing a Pandemic Continuity of Operations Plan for the HNHU. Increasing public awareness regarding pandemic activities. Delivering pandemic preparedness and response education and training for HNHU staff. Ensuring that local government officials are briefed on the Board of Health s Pandemic Plan. Communicating with national, provincial and municipal agencies to coordinate surveillance, investigation and vaccine activities. Establishing clear communication strategies/systems amongst county departments, essential service providers, partners and stakeholders. Planning for and delivering mass immunizations and treatment, including vaccines, antivirals and medical supplies. Assessing local health-care capacity and helping identify additional or alternative resources. Liaising with local community partners and stakeholders. Collaborating with the provincial government to deliver public education programs. Communicating to the public information regarding personal preventative measures and the management of the local outbreak by the HNHU. To accomplish the above items, the HNHU Emergency Control Group (ECG) has been created. 2.2 The Incident Management System The Government of Ontario has implemented legislation that makes emergency management mandatory for all municipalities. Municipalities must have plans in place to Haldimand Norfolk Health Unit Influenza Pandemic Plan

15 respond to emergencies effectively. The Incident Management System (IMS) has been adopted for both municipalities by the HNHU and will be used to respond to any emergency situation, including a pandemic influenza outbreak. The IMS is an international emergency management structure that has been adopted by Emergency Management Ontario (EMO) as the operational framework for emergency management in the province. It provides the basic structure and functions required to respond and manage an emergency effectively. The IMS has five functions: command, operations, planning, logistics and administration. These functions are the foundation upon which the IMS is based and can be applied to a routine incident, organizing for a major event such as a pandemic or managing a major response to a disaster. Figure 2-1 outlines these functions and structure. Figure 2 1 IMS Framework Command Communications Safety Operations Planning Logistics Administration Business Continuity 1. Command. This function determines the flow of decision-making and communications. The person performing this role is given the title of Incident Commander. The Incident Commander exercises overall responsibility for the incident and reports to the Pandemic Emergency Control Group (PECG). In a public health emergency, the Incident Commander will lead the Command function and the overall response effort. As the incident expands, the Incident Commander may activate the Communications, Safety and General Staff units as necessary Haldimand Norfolk Health Unit Influenza Pandemic Plan

16 2. Safety. This function advises the Incident Commander on all operational matters related to occupational health and safety, including volunteers. 3. Communications. This function is responsible for media relations, communication strategies, rumour control, etc., and releasing information about the incident. 4. Operations. This function is responsible for managing the response to the emergency. 5. Planning. This function is responsible for assessing the situation and creating an Incident Action Plan (IAP) to identify objectives for the emergency response and response activities. This position is also responsible for creating and maintaining a business continuity plan to ensure regular services are continued as necessary. 5 i. Business Continuity. This function refers to a continuous process that includes advance plans, arrangements and procedures to maintain business functions and minimize interruptions when internal or external influences have an impact on a business's capacity to operate. 6. Logistics. This function is responsible for providing facilities, services, materials and personnel to support the response activities. This section is very important in long-term or extended operations by organizing and confirming the availability of staff. 7. Administration. This function is critical for tracking all expenses, expenditures, claims, purchases and contracts initiated during the emergency. Various subgroups with specific mandates may be organized under the above units in what are known as Emergency Support Functions (ESFs). This will allow the Incident Commander and the other key staff in the Emergency Operations Centre to concentrate on the actual management of events as they unfold by delegating specific staff members to deal with these various support functions Responding to an Influenza Pandemic Using IMS Responding to an influenza pandemic in Haldimand and Norfolk will require a coordinated response from the health sector, public health and each municipality. IMS will be used to coordinate the response between all areas involved. Figure 2-2 indicates how the response will be applied to each jurisdiction. Haldimand Norfolk Health Unit Influenza Pandemic Plan

17 Figure 2 2 Incident Management System (IMS) HNHU-IMS Model Public Health Incident Manager PECG Structure Public Information Liaison Operations Planning Logistics Administration Mass Vaccination/Post- Exposure Prophylaxis Situation Assessment Facilities Claims/ Compensation Hotline Operation Staffing & Resource Needs Human Resources Costing Reception Centre/Mass Care Case Management/Contact Tracing Resource Deployment Documentation Communications Equipment Miscellaneous Supplies Procurement Environmental Inspection/ Sampling Epidemiological Investigations Demobilization & Recovery Nutrition/Staff Accommodation Psychosocial Intervention The HNHU s IMS Team 2.2.2A Incident CommandER (IC) The Incident Commander will be responsible for the overall management of the pandemic response. He/she will be authorized by the Health Protection and Promotion Act and he/she will ensure an appropriate incident management command structure is used. Reports to: ECG. Incident Commander Role and Responsibilities: Works closely with HNHU Command Group and Municipal Response Directors to: o Ensure safety of all responders. o Assess the situation. o Establish a cycle of planning meetings with the Command Group. o Manage sensitive or political issues arising from the incident. o Approve the release of health information to the media. Haldimand Norfolk Health Unit Influenza Pandemic Plan

18 2.2.2B Operations in charge Person(s) filling the role of Operations In-Charge is/are responsible for managing the response to the emergency. Reports to: IC. Task Responsibilities During a Pandemic: 1- Hotline operation Population Health 2- Case management CD Manager 3- Epidemiology Epidemiologist 4- Mass immunization Clinical Service 5- Infection control CD and MOH 6- Psychosocial Family Health & Healthy Babies Healthy Children (HBHC) 7- Animal care Healthy Environment 8- Community-based activities MOH Operations In-Charge Role and Responsibilities: o Directs and coordinates all health operation response. o Contributes in determining the pandemic incident objectives and priorities in developing the Incident Action Plan (IAP). o Implements the IAP during a pandemic. o Identifies staffing and resources needs. o Regularly reports to the Incident Commander o Requests and assigns resources as directed. o Maintains a personal log of all actions taken C Planning In charge Person(s) filling the role of Planning In-Charge is/are responsible for assessing the situation and creating an IAP to identify objectives for the emergency response and response activities. This position is also responsible for creating and maintaining a business continuity plan to ensure regular services are continued as necessary. Reports to: IC. Planning In-Charge Role and Responsibilities: o Develops alternatives for operation and plans for future development. Haldimand Norfolk Health Unit Influenza Pandemic Plan

19 o Develops contingency plans to keep regular services going and prepares the IAP. o Assesses the present situation and projected situation, including possible contingency plans, long-range plans and alternative courses of action. o Ensures business continuity throughout the health sector. o Ensures information management systems collect, manage, share and file information and documentation. o Addresses the short- and long-term consequences on the health-care sector and plans for the immediate provision of services and supplies. o Provides a timely transition to recovery operations when deemed appropriate. o Maintains a personal log of all actions taken. o Regularly reports to the Incident Commander. Task Responsibilities During a Pandemic: 1- Surveillance activities Epidemiologist 2- Business continuity Public Health Manager/Emergency Planner 3- Situation report Public Health Manager/Emergency Planner 4- Staffing resources Family Health Coordinator/HBHC Coordinator 5- Document control Administrative Assistant 2.2.2D Logistics In Charge Person(s) filling the role of Logistics In-Charge is/are responsible for providing facilities, services, materials and personnel to support the response activities. This section is very important in long-term or extended operations in organizing and confirming the availability of staff. Reports to: IC. Task Responsibilities During a Pandemic: o Facilities Healthy Environment Coordinator o Human resources Family Health Coordinator/ HBHC Coordinator o Supplies and equipment Business Administrator and/or Administrative Assistant o Staff accommodation Population Health Logistics In-Charge Role and Responsibilities: o Coordinates and directs medical supplies, staff needs (transportation, accommodation, nutrition and training) and facilities. Haldimand Norfolk Health Unit Influenza Pandemic Plan

20 o Provides all necessary support and volunteers to support the pandemic response. o Coordinates the set up of additional facilities (e.g., immunization clinics, briefing rooms, etc.). o Organizes training for new staff and redeployed staff using operations expertise. o Identifies availability of supplies and support. o Arranges for temporary services and rental or purchase of resources from private sector or NGOs. o Monitors the level of supplies and rates of consumption. o Advises Operation In-Charge of current or anticipated shortage. o Organizes and confirms 24-hour availability of staff, resources and other facilities. o Reports regularly to Operation In-Charge. o Maintains a personal log of all actions taken E Finance/Administration Person(s) filling the role of Finance/Administration is/are responsible for tracking all expenses, expenditures, claims purchases and contracts initiated during the emergency. Reports to: IC. Finance/Administration In-Charge Role and Responsibilities: o Coordinates and directs procurement, cost tracking and human resources. o Handles all accounting and payroll and ensures required purchases are made. o Consults and responds as needed on legal, human resource (including union contracts) and insurance issues. o Monitors expenditure tracking for staff services, health resources, supplies and equipment. o Sets up and maintains the HNHU emergency operations room, including secretarial support. o Identifies staffing and resource needs. o Seeks financial assistance from senior levels of government. o Maintains a personal log of all actions taken. o Regularly reports to the Incident Commander. Haldimand Norfolk Health Unit Influenza Pandemic Plan

21 2.2.2F Liaison and Public Information OFFICER Person(s) filling the role of Liaison and Public Information Officer is/are responsible for media relations, communication strategies, rumour control, etc., and releasing approved information about the incident. Reports to: IC. Liaison and Public Information Officer's Role and Responsibilities: o Coordinates with outside agencies and personnel to ensure awareness of the pandemic and clarifies roles. o Establishes formal communications with participating agencies and services. o Identifies contact persons and contact numbers for participating agencies. o Identifies current or potential interagency cooperation needs. o Identifies current and potential interagency problems. The Liaison and Public Information Officer: o Will be a point of contact for the media. o Manages all public information regarding the pandemic. o Prepares messages and releases significant information approved by IC. o Monitors the media to ensure that they are accurately reporting information to the public. o Coordinates media briefings and conferences and prepares and briefs spokespeople. o Updates website information. o Investigates and manages rumours related to the emergency. o Works closely with IC. o Maintains a personal log of all actions taken G Safety Officer Person(s) filling the role of Safety Officer is/are responsible for advising the Incident Commander on all operational matters related to occupational health and safety, including volunteers. The Safety Officer(s) is/are also responsible for monitoring and ensuring all activities regarding the incident follow occupational health and safety standards. Reports to: IC. Safety Officer's Role and Responsibilities: Haldimand Norfolk Health Unit Influenza Pandemic Plan

22 o Advises IC on all operational matters related to occupational health and safety, including volunteers. o Controls and reduces occupational hazards and exposures. o Reviews all operations from a safety perspective. o Creates policies and procedures related to the overall health and safety of staff and volunteers. o Ensures MOHLTC directives are applied and carried out. o Alters, suspends or terminates any or all activities that are deemed hazardous. o Provides direction regarding infection-control measures. o Maintains a personal log of all actions taken. 2.3 Operation Cycle For clear communication, situation analysis and strategic planning to occur, the Emergency Response Group must meet regularly throughout the pandemic response. This usually takes the form of an Operation Cycle and is called by and chaired by the Incident Commander. The purpose of the Operation Cycle is to gather the response group members together periodically for information sharing, brainstorming, decisionmaking and plan development. The findings are recorded and reviewed against the response objectives and priorities. From the review, operational instructions are issued to address any concerns and requirements. Only the Incident Commander or Response Director may change response objectives and priorities Timing of the Operation Cycle The timing of the operation cycle is the responsibility of the Incident Commander and/or Response Director. Depending on the intensity of the operation and the situation, the cycle may be lengthened or shortened. For example, during the initial stages of an emergency, when information may be imprecise, it may be necessary to conduct the meetings more frequently. In the latter stages of the emergency, the operation cycle may be lengthened. It is important to set an appropriate time for the operation cycle to run. This will ensure that there is sufficient time for the response groups to meet and discuss the response to the incident and allow time for the emergency support functions to address the priorities and objectives. Haldimand Norfolk Health Unit Influenza Pandemic Plan

23 2.3.2 Meeting Portion of the Operation Cycle 1. The Incident Commander, Response Director, Chief or Lead chairs the meeting. 2. All necessary members of the Response Group attend to discuss response priorities and objectives. 3. Brainstorming is conducted for possible future scenarios and responses. 4. Identify and record all priorities and objectives. 5. Incident Commander, Response Director, Chief or Lead delegates action tasks to the support staff. 6. Response Group members provide updates on their previous to-do list items if required. 7. Conduct fast round-the-table updates including review of to-do lists from previous meeting. 8. Decisions to be brief and to the point. 9. Set time for next meeting. 10. Adjourn meeting. 11. Chiefs return to respective teams and leads to discuss to-dos for the cycle Working Portion of the Operation Cycle 1. Incident Commander meets with respective response teams or leads. 2. Delegate the response priorities and objectives set out in the to-dos from the Response Group meeting to the teams and/or leads. 3. Members of the response teams and/or leads work at meeting the priorities and objectives. 4. Leads/teams provide feedback to Chief regarding progress, questions, problems and other issues that might have come up since the last cycle. The respective Chief then takes these issues to the next Response Group meeting to discuss. Haldimand Norfolk Health Unit Influenza Pandemic Plan

24 2.4 Ethical Framework for Influenza Pandemic Planning, Response and Recovery 1 All levels of government will have to make difficult decisions based on an ethical framework. Ethical considerations include honesty and transparency, with clear reasons provided for decisions related to the allocation or prioritization of scarce resources (e.g., access to vaccine and antiviral medications). An ethical framework ensures stakeholder involvement in the decision-making process with accurate communication. The following outlines how the HNHUIPP has adopted the Ethical Framework for Decision-Making as outlined in the OHPIP Decision Making Principles Openness and transparency. The process by which decisions are made must be open to scrutiny and be explained. Community stakeholder participation is an important component throughout the entire planning process. Outreach and consultation with stakeholders is an ongoing process, especially as updated versions of the federal and provincial plans become available. Value-driven decision-making based on evidence and principle will be made by people who are credible and accountable. The HNHUIPP is closely aligned with the direction provided by the federal and provincial influenza pandemic plans. Planning decisions made were based on input from the following groups and resources: ECG members. Work Group members. Other sector-specific stakeholders. Infectious disease/infection control experts. Current literature. MOH. 1 Adapted from: Gibson, J. et al. Ethics in a Pandemic Influenza Crisis. Framework for Decision Making. Joint Centre for Bioethics. University of Toronto Haldimand Norfolk Health Unit Influenza Pandemic Plan

25 Inclusivity. Decisions should be made explicitly with stakeholder views in mind, and stakeholders should have opportunities to be engaged in the decision-making process. HNHUIPP has adopted a key stakeholder model for the development of a comprehensive approach to planning, response and recovery from an influenza pandemic. Input from stakeholders in the health sector, emergency planners, non-government volunteers, the community and both public and private business sectors was provided and will continue to be gathered. Responsiveness. Decisions should be revisited and revised as new information emerges, and stakeholders should have opportunities to voice any concerns they have about the decisions (i.e., the dispute and complaint mechanism). HNHUIPP will continue to be developed, enhanced and revised as new information emerges from the federal and provincial plans. Opportunities for input will continue through larger reference groups, focus groups for sector-specific consultations, etc. Accountability. Mechanisms will be developed to ensure accountability and sustained ethical decision-making throughout the pandemic. Haldimand and Norfolk s response to an influenza pandemic will be based on the following core ethical values as outlined in the OHPIP Core Ethical Values Individual Liberty. This may be restricted in order to protect the public from serious harm. Restrictions to individual liberty will: Be proportional to the risk of public harm. Be necessary and relevant to protecting the public good. Employ the least restrictive means necessary to achieve public health goals. Be applied without discrimination. Protection of the Public from Harm. Measures may be implemented to protect the public from harm. Protective measures will include the following: Assessing the benefits of protecting the public from harm against the loss of liberty of some individuals (e.g., isolation). Ensuring that all stakeholders are aware of the medical and moral reasons for the measures, the benefits of compliance and the consequences of failing to comply. Haldimand Norfolk Health Unit Influenza Pandemic Plan

26 Establishing mechanisms to review decisions as the situation changes and address stakeholder concerns and complaints. Proportionality. Restrictions on individual liberty and measures taken should not exceed the minimum required to address the level of risk or community needs. Haldimand and Norfolk will do the following: Use the least restrictive or coercive measures possible when limiting or restricting liberties or entitlements. Use more coercive measures only in circumstances in which less restrictive means have failed to achieve appropriate public health ends. Privacy. Individuals have a right to privacy, including the privacy of their health information. Haldimand and Norfolk will: Determine whether the good intended is significant enough to justify the potential harm of suspending privacy rights (e.g., the potential stigmatization of individuals and communities). Require private information only if there are no less intrusive means to protect health. Limit any disclosure to only that information required to achieve legitimate public health goals. Take steps to prevent stigmatization (e.g., public education to correct misperceptions about disease transmission). Equity. All patients have an equal claim to receive the health care they need, and healthcare institutions are obligated to ensure a sufficient supply of health services and materials. During a pandemic, tough decisions may have to be made about who will receive antiviral medication and vaccinations and which health services will be temporarily suspended. The HNHU will do the following: Strive to preserve as much equity as possible between the needs of influenza patients and patients who need urgent treatment for other diseases. Establish fair decision-making processes/criteria. Identify diversity and respect, wherever possible, ethno-cultural faith practices. Haldimand Norfolk Health Unit Influenza Pandemic Plan

27 Duty to Provide Care. Health-care workers have an ethical duty to provide care and respond to suffering. During a pandemic, demands for care may overwhelm health-care workers and their institutions and create challenges related to resources, practice, liability and workplace safety. Health-care workers may have to weigh their duty to provide care against competing obligations (e.g., to their own health, family and friends). When providers cannot provide appropriate care because of constraints caused by the pandemic, they may be faced with moral dilemmas. To support providers in their efforts to discharge their duty to provide care, Ontario and/or Haldimand and Norfolk will: Work collaboratively with stakeholders, regulatory colleges and labour associations to establish practice guidelines. Work collaboratively with stakeholders, including labour associations, to establish fair dispute-resolution processes. Strive to ensure that the appropriate supports are in place (e.g., resources, supplies, equipment). Develop a mechanism for provider (HNHU staff) complaints and claims for work exemptions. Reciprocity. Society has an ethical responsibility to support those who face a disproportionate burden in protecting the public good. During a pandemic, the greatest burden will fall on public health practitioners, other health-care workers, infected patients, and their families. Health-care workers will be asked to take on expanded duties. Decision-makers will take steps to ease the burdens of health-care workers, patients and patients families. They may be exposed to greater risk in the workplace, suffer physical and emotional stress and be isolated from peers and family. Individuals who are isolated may experience significant social, economic and emotional burdens. Trust. Trust is an essential part of the relationship between government and citizens, between health-care workers and patients, between organizations and their staff, between the public and health-care workers and among organizations within a health-care system. During a pandemic, some people may perceive measures to protect the public from harm (e.g., limiting access to certain health services) as a betrayal of trust. In order to maintain trust during pandemic, decision-makers will take steps to build trust with stakeholders before the pandemic occurs (e.g., by engaging stakeholders early) and ensure that decision-making processes are ethical and transparent. Solidarity. An influenza pandemic will require solidarity among the community, healthcare institutions, health units and governments. Solidarity requires good communication Haldimand Norfolk Health Unit Influenza Pandemic Plan

28 and open collaboration within and among these stakeholders to share information and coordinate health-care delivery. Stewardship. In our society, both institutions and individuals will be entrusted with governance over scarce resources, such as vaccines, ventilators, hospital beds and even health-care workers. Those entrusted with governance should be guided by the notion of stewardship, which includes protecting and developing one s resources and being accountable for the public's wellbeing. To ensure good stewardship of scarce resources, decision-makers will consider both the benefit to the public good and equity (i.e., the fair distribution of benefits and burdens). 2.5 Legislation The Emergency Planning Act is the primary authority enabling municipalities to develop their own emergency plans. Section 4(1) of the Emergency Plan Act states: The head of council of a municipality may declare that an emergency exists in the municipality or in any part thereof and may take such action and make such orders as he or she considers necessary and are not contrary to law to implement the emergency plan of the municipality and to protect property and the health, safety and welfare of the inhabitants of the emergency area. Section 12(1) of the Town of Norfolk Act describes the municipal boundaries of both Norfolk County and Haldimand County as a Health Unit under clause 96(5)(a) of the Health Protection and Promotion Act (HPPA), under the name Haldimand-Norfolk Health Unit. Under the HPPA, the MOH has the authority to identify, reduce and/or eliminate health hazards and to take the necessary actions to control communicable diseases Legal Basis The MOH determines the actions needing to be taken to protect the population from communicable disease as outlined in the HPPA, revised statutes of Ontario, 1990 Chapter H.7. In addition, the MOH has the authority to issue an order under Section 22 of the HPPA with respect to a communicable disease if he or she is of the opinion, upon reasonable and probable grounds, that a communicable disease exists or may exist or that there is an immediate risk of an outbreak of a communicable disease in the Health Unit served by the Medical Officer of Health. Influenza is a reportable disease as defined by the HPPA. Therefore, health professionals must report diagnoses of influenza meeting the case definition to the local MOH. Haldimand Norfolk Health Unit Influenza Pandemic Plan